File #

2017GRANT APPLICATION

Grant Applicant Information

Please read the Granting Guidelines before applying.

Revenue Canada Charitable Registration Number:

Legal name of Registered Charitable Organization:

Contact Name, title:

Mailing Address:

City/town:Postal Code:

Tel: ( )Fax: ( )Email:

Organization carrying out project (if different from above):

Project Contact Name, title:

Mailing Address:

City/town:Postal Code:

Tel: ( )Fax: ( )Email:

SUMMARY PAGE

  • Project title:
  • Project description:
  • Project objectives:
  • Amount requested from the Osprey Community Foundation $______

List main budget items:

  • Is the proposed project part of a larger initiative? ( ) Yes ( ) No

If yes, indicate total project budget: $______

  • Previous requests for funds from Osprey, including years and amounts awarded:

SECTION A: OUTLINE OF PROPOSED PROJECT

Please be as brief and concise as possible.

  1. Project duration, from: ______to:______
  1. Purpose: Whatneed(s) will the project address? How were needs identified? How will project objectives help address these identified needs?
  1. Who will benefit from this project, directly and indirectly? How will they benefit? (Benefits can be to a large number of people in the community, to those most in need, and/or to the organization itself.)
  1. Does the project build on previous ones? How does it complement or connect withothercommunity initiatives? If this project is part of a larger one, explain how the activities funded by this grant would contribute to overall success.
  1. Evaluation: What are your criteria for success for the project, and how will you know you have met them?
  1. Plan of Action and Project Activities: Describe who will do what, and specifically how the Osprey grant will be used.
  1. If this grant is not time limited, how do you plan to sustain it?

SECTION B – PROJECT BUDGET

Please provide the full budget for the proposed project and highlight what you are asking the Osprey Foundation to fund.The “proposed amount from Osprey” should match your funding request on page 1.

Expenditures

Item / Description / Cost / Proposed Amount from Osprey
Salaries/benefits
Professional fees/honoraria
Rent/utilities
Tel/fax/other communications
Office supply/equip/postage
Printing/photocopying
Travel
Publicity/promotion
Production costs
Evaluation
Other (specify):
Total Expenditures:

What are Your Sources of Revenue other than Osprey?

(value volunteer time at $10 per hour)

Source / $ Assured / $ Potential / Contact name and tel.
Your Organization
(e.g., cash, in-kind or volunteer contributions)
Additional contributors other than Osprey, pending or approved
Total from other sources:

SECTION C–RECOGNITION

How will you recognize the support provided by Osprey Community Foundation (check all that apply)

  • Use Osprey logo on your web site, publications, signage or advertising
  • Include an article about the grant in a newsletter
  • Prepare a media release about the grant
  • Borrow a banner from Osprey for an event you are hosting
  • Social Media post
  • Other

Applications signed with a digital signature are acceptable. Alternatively, you can electronically submit your completed application without a signature, and in the event your application is successful, we will obtain a signature at a later date
SECTION D - SIGNATURES

Applications signed with a digital signature are acceptable. Alternatively, you can electronically submit your completed application without a signature, and in the event your application is successful, we will obtain a signature at that time.

Initiator/Preparer of Application, title:

Signature:

Date

Applicant Chairperson/Board Member, title:

Signature:

Date

Osprey Community Foundation – Grant ApplicationPage 1